Provider Demographics
NPI:1578007589
Name:THOSAR, KETKI
Entity type:Individual
Prefix:
First Name:KETKI
Middle Name:
Last Name:THOSAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6308 DEMOCRACY BLVD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1664
Mailing Address - Country:US
Mailing Address - Phone:301-530-2383
Mailing Address - Fax:301-530-5802
Practice Address - Street 1:3100 NC 55 HWY STE 101
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8427
Practice Address - Country:US
Practice Address - Phone:919-290-2799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-09
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305212625225100000X
MD26217225100000X
NCP21346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist